Mordacci - It's worth reminding the case of Nancy Cruzan occurred in the United States at the end of the seventies. Nancy was a girl that, on consequence of an accident, got to a condition called “ persistent vegetative condition “.... 

L.M. - That means that she was kept in life by the means of artificial hydration and feeding... 

Mordacci - ....really it was not always necessary the employ of the artificial respirator. To get a decision about going on with treatment they decided to appeal the magistracy and the Supreme Court of the United States arranged to stop the treatment basing on the fact that there was a witness according to whom the girl had expressed previously the will to not going on living if she would have ever been in a condition alike. 

L.M. - So the basic element of the decision has been the will, a criterion not always applicable. 

Mordacci - That the “persistent vegetative condition “ performs a case of life sustain medical treatment is on my opinion, and at any extent, open to challenge. It must make distinctions. There are situations in which therapies, absolutely useless, are applied, as in the cases of cancer or intensive therapies. These cases, the expression life sustain medical treatment fits. 

L.M. - You have asserted that medicine is oriented to this praxis. 

Mordacci - Surely, since in the contemporaneous conscience there are three facts we must keep well  in mind. First the technological imperative. When machines are on disposal they must be employed. The second one is given by a sort of bad conscience, that is the feeling that we must not let death come and we must do all it is possible so that it does not happen, otherwise we would feel guilty. The third one is the paternalism. The idea that we must decide for others.. 

L.M. - And what about the concept involving our freedom in establishing  when to die? 

Mordacci - Really this way of mind is equivocal. Wanting one's own death is, in the sizeable cases, the signal regarding something else. Wanting one's own death so to escape agony is an illusion since suffering, if culturally worked-through,  must be faced. 

L.M. - Which is the position of the Catholic Church as regards to the life sustain medical treatment? 

Mordacci - Pope Pio XII spoke about this matter in the fifties during a speech to anaesthetists and intensive care operators. On this circumstance he cleared that for the moral theology it was admissible to stop the “extraordinary” therapies for patients hopeless to recover, while it must be kept only the common treatment. 
L.M. - Has there been a change in this position afterwards? 
Mordacci - Nowadays the Church prefers talking about “excessive” and “proper” treatments, just for there cannot be anymore a subjective list to be always applied , but cases must be examined one by one. Any clinic situation must be considered as a special one. Anyhow the principle is the same. On my opinion it must be talked about life sustain medical treatment whenever excessive therapies are in use - and so not only for the most serious cases . 

L.M. - Let's get back to the case you have mentioned at the beginning of the interview: let's refer to the previous will of the patient. It seems to me that the magistracy sometimes has gone beyond this point of view. 

Mordacci - You are referring to the case of the seventeen years old Tony Bland, the fan of the Liverpool who during a football match, on April 15th  1989, has been run over by the crowd. The House of Lords, the last rank of the English Magistracy, arranged that the cures of feeding, hydration and artificial respiration did not give any advantage and must be stopped even in absence of a specific will of the involved person. The sentence is important since it fixes a principle: that of quality of life. According to what the English  judges asserted, it is not worthwhile living life if its quality is poor- quality. I cannot accept an assertion alike. How can it be said that life must be accepted only if depending on a certain quality? The rejection of suffering brings us to a moral problem, concerning faith, we must not pretend to ignore. 
 

Lecaldano - We can refer to the definition of a German philosopher, Hans Jonas, according to whom there's life sustain medical treatment anytime a dying person is passively subjected to the modern medical techniques, oriented to prolong life artificially 

L.M. - Which is your point of view about the expediency in going on with these techniques?  

Lecaldano - Meanwhile we must take cognisance that there's no ethical position in favour of the life sustain medical treatment. The expression itself, also by the mere linguistic point of view, is negative. 
Nobody may approve it.  But we must not make us mistaken by such an opposite position. Instead  we must go beyond the form and see if behind this common position there are differences. Furthermore we must see who takes the decision if we are facing a life sustain medical treatment situation and what we can do to avoid it. 

L.M. - Let's deal instead with the case of a patient, who, notwithstanding is affected by a terminal disease, is going on being cured with therapies even painful.  

Lecaldano - I think that the patients themselves sense if they are subjected or not to life sustain medical treatment. But many deem that it lies with physicians and not with patients to say whenever there's a condition of life sustain medical treatment. 

L.M. - We face different strategies and different ethics...  

Lecaldano - On a side there's the ethics concerning the people freedom, on the other side there's the ethics denying the availability of one's own body, the ethics bearing that dead is a natural process, that it must be wait for and so on. 

L.M. But if we are free in deciding what do of our life, then we are close to the concept of euthanasia.  

Lecaldano - When we state that we are free to make of our life what we want we may find different cases. Some patients ask to not begin cures or to stop cures. We can refer back to the self-determination charts, the will expressed by a person before being in an incurable clinic condition. Euthanasia, strictly intended, does not concern the two mentioned conjectures. 

L.M. - Don't you think that the trend in medicine, beyond the philosophic opinions, is instead that of insisting on life sustain medical treatment?  

Lecaldano - We must be clear. Who makes all he can to keep in life a person by using machines is not a defender of a natural death, but replaces this concept with the power of machines. 

L.M. - Professor I can't avoid asking you that wrote a book “ Bioetica, le scelte morali”, (Bioethics and moral choices) published by Laterza, which is the most delicate aspect of bioethics for the next future.  

Lecaldano - Those concerning bioethics are all very important matters requiring a grow in people dealing with it. We cannot solve these problems by using old principles, we must individuate new moral principles, and we must not let things being defined by nature o policy.

D'agostino - There's no and there must not be, on my opinion, a special law for this kind of situations, that are always extreme situations.  Indeed when we talk about life sustain medical treatment we refer to cases in which it comes into play an use of medicine, particularly technological and that makes the limits between common medical practice and experimental medical practice fade. The Right, I repeat it, cannot manage extreme situations, but only the common, typical, repeatable and frequent ones. 

L.M. - What do you think about those painful therapies practised to whom is affected by a disease deemed incurable? 

D'agostino - If chemotherapy is arbitrarily imposed to patients by physicians, and does not bring any even partial positive effect, it must deemed as life sustain medical treatment. Even when it does not concern a terminal disease situation, if the physician fires the patient with medicines not indicated or not corroborated by the international scientific community for this specific case, he would behaviour in a no deontologic way, he would perform an unjust medical act. 

LM. - There's an ethical trend that nowadays insists on the freedom in choice by man or judges in commanding or not life. What do you think about this? 

D'agostino - Commanding other people's life is a matter, commanding one's own is another. In the first case a formula is commonly added: “if quality of life drops or is irremediably lost.” In the other case - in which disposability of one's own life is the matter at point - the reference to quality life is weaker. It's harrowing see a patient suffering. But it concerns emotions. If a law ruled such a situation we would be in front of a juridical system giving somebody the power of life and death over other people. 

L.M. - Will you please make an example? 

D'agostino - Think about the huge problem concerning disabled. Who does not feel a pang in one's heart thinking about how hard is life for them? But those having daily experience with them that is relatives, family, are the first in defending them. What appears emotionally unbearable to strangers is sensed in a completely different way by others. Well then quality life is not an objective category, but easily deferrable by emotive factors. 

L.M. - And the mentioned example regarding Holland quoted as the leading country for this kind of laws? 

D'agostino - Remind that in Holland 25 per cent of the cases of euthanasia concern mental patients. So it is not ever even mentioned that mental patients cannot marry, cannot make testament since it would be juridical void, but can instead ask for euthanasia and it would be practised to him. It's an aberration. 

L.M. - Professor, but if is the subject to ask for his death? 

D'agostino - It's a big sophism. Those sponsoring it must have the courage to get to the last consequences. 
I mean, if a subject affected by pathologies as neurosis or disabling but not terminal pathologies asks for euthanasia, it must be proper go through the end, be coherent and practise it to him. I've never met anybody able to answer me this point. 

L.M. - And if the request comes from a terminal patient? 

D'agostino - I do not reject that in extreme cases the terminal patient could really be brought to die. But we have already a huge psychological kind literature that shows us the request of euthanasia by terminal patients in a different slant, quite from the common one. Many times the request of the terminal patient is coded. He wants to be cared for, he does not want to be left alone, and he wants his relatives close to him. 
If all that is not allowed, the patient says he wants to die. If there's a health system not allowing all that, for an economic factor too, the response of the patient is to be expected. 
But then the autonomy of persons matter is totally beside the point. 

Throughout the interviews we collect it appears evident the contrast between the two ethical conceiving of life. 
It's undeniable that for the Christian confessions the approach to death is different from the Eskimos' traditional one, as well as it's different from those of other populations with different cultural backgrounds. In Italy it is not possible to broach the matter of the euthanasia as it is in Holland (see “Leadership Medica”, 5/88), it concerns two cultural worlds completely opposite and so showing different problems.